Timing of Antibiotics in Diabetic Foot Infections

A is admitted to the for a diabetic foot infection (DFI)with concern for osteomyelitis. He is not septic and awaiting surgical plans

What is the BEST antibiotic plan?

A. HOLD antibiotics
B. Start vancomycin
C. Start cefepime
D. Start vanc + cefepime

How did others respond?

Reveal the answer

Best Answer

HOLD antibiotics 🛑

Explanation: The 2023 IWGDF/IDSA Guidelines recommend collecting tissue or bone cultures to tailor antibiotic therapy. IDEALLY a patient doesn’t get antibiotics for >2 weeks before culture collection 🧫

Why do the guidelines suggest this? Pre-op antibiotics decrease growth in operative cultures in DFIs 👎

One retrospective study found that cultures were NEGATIVE in 19% of cases with pre-op antibiotics vs ONLY 6% with no antibiotics 🤯

If patients are septic, benefits of treatment outweigh the risks of poor culture yield. But we should stop 🛑 and consider holding empiric antibiotics in stable patients with DFIs!